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YALE UNIVERSITY PRESS HEALTH & WELLNESS
A Yale University Press Health & Wellness book is an
authoritative, accessible source of information on a
health-related topic. It may provide guidance to help
you lead a healthy life, examine your treatment options
for a specic condition or disease, situate a healthcare
issue in the context of your life as a whole, or address
questions or concerns that linger after visits to your
healthcare provider.
Ruth Grobstein, M.D., Ph.D., The Breast Cancer Book:
What You Need to Know to Make Informed Decisions
James Hicks, M.D., Fifty Signs of Mental Illness: A Guide to
Understanding Mental Health
Mary Jane Minkin, M.D., and Carol V. Wright, Ph.D., A
Womans Guide to Menopause and Perimenopause
Mary Jane Minkin, M.D., and Carol V. Wright, Ph.D., A
Womans Guide to Sexual Health
Catherine M. Poole, with DuPont Guerry IV, M.D.:
Melanoma: Prevention, Detection, and Treatment, 2nd ed.
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James Whitney Hicks, M.D.
Fifty Signs of Mental Illness
A Guide to
Understanding
Mental Health
Yale University Press / New Haven and London
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Copyright 2005 by James Whitney Hicks. All rights reserved. This
book may not be reproduced, in whole or in part, including illustrations,
in any form (beyond that copying permitted by Sections 107 and 108 of
the U.S. Copyright Law and except by reviewers for the public press),
without written permission from the publishers.
Designed by Nancy Ovedovitz and set in Sabon type by Binghamton
Valley Composition. Printed in the United States of America by Vail-
Ballou Press
Library of Congress Cataloging-in-Publication Data
Hicks, James Whitney.
Fifty signs of mental illness : a guide to understanding mental health /
James Whitney Hicks.
p. cm.(Yale University Press health & wellness)
Includes index.
ISBN 0-300-10657-2 (cloth : alk. paper)
1. Psychology, Pathological. 2. Mental illness. I. Title. II. Series.
RC454.H536 2005
616.89dc22 2004021535
A catalogue record for this book is available from the British Library.
The paper in this book meets the guidelines for permanence and durabil-
ity of the Committee on Production Guidelines for Book Longevity of the
Council on Library Resources.
10 9 8 7 6 5 4 3 2 1
The information and suggestions in this book are not intended to replace
the services of your physician or caregiver. Because each person and each
medical situation is unique, you should consult your physician to get an-
swers to your personal questions, to evaluate any symptoms you may
have, or to receive suggestions on appropriate medications.
The author has attempted to make this book as accurate and up-to-date
as possible, but it may nevertheless contain errors, omissions, or material
that is out of date by the time you read it. Neither the author nor the
publisher has any legal responsibility or liability for errors, omissions, out-
of-date material, or the readers application of the medical information or
advice in this book.
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To Colin, da te la vita prende ogni splendore
To my parents for encouraging me to write, teach, and listen
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Over the victim
We sing this song of madness
Distracting and destroying the mind.
Aeschylus, The Furies, c. 458 B.C.
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Contents
xiii Acknowledgments
1 Introduction
9 Anger
13 Antisocial Behavior
21 Anxiety
27 Appetite Disturbances
37 Avoidance
42 Body Image Problems
47 Compulsions
54 Confusion
59 Cravings
72 Deceitfulness
77 Delusions
84 Denial
91 Depression
107 Dissociation
114 Euphoria
117 Fatigue
121 Fears
125 Flashbacks
128 Grandiosity
133 Grief
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x C O N T E N T S
139 Hallucinations
143 Histrionics
147 Hyperactivity
157 Identity Confusion
162 Impulsiveness
168 Intoxication
180 Jealousy
184 Learning Difculties
194 Mania
206 Memory Loss
216 Mood Swings
221 Movement Problems
227 Nonsense
232 Obsessions
241 Oddness
246 Panic
251 Paranoia
257 Physical Complaints and Pain
267 Psychosis
280 Religious Preoccupations
285 Self-Esteem Problems
295 Self-Mutilation
300 Sexual Performance Problems
309 Sexual Preoccupations
319 Sleep Problems
328 Sloppiness
333 Speech Difculties
337 Stress
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C O N T E N T S x i
341 Suicidal Thoughts
348 Trauma
359 Recommended Resources
377 Index
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Acknowledgments
Several friends and family members took time to make sugges-
tions, read drafts of my manuscript, and provide valuable feed-
back. Thanks to Nishith and Suman Bhattacharyya, Alison Bethel
and Alfredo Pastor, Colin Bethel, Jeanette Bethel, Terence Bethel,
Lynn and Steve Clayton, Joe and Linda Hicks, Teri Jacobs, Louise
Phillips, and Tom Wells. I especially appreciate the feedback on
chapters dealing with child mental health provided by my col-
league Paulina Loo, a child psychiatrist at Columbia University,
College of Physicians and Surgeons, and director of the elemen-
tary school-based mental health program at Childrens Hospital
of New York-Presbyterian.
Elizabeth Law provided valuable guidance in the world of pub-
lishing. Thanks to my agent, Glen Hartley, and to my editors at
Yale University Press: Jean E. Thomson Black, Erin Carter, and
Jeffrey Schier. Thanks also to my colleagues at Yale University,
Kirby Forensic Psychiatric Center, the New York State Ofce of
Mental Health, and New York University Medical Center.
I am most indebted to the patients I have worked with in Con-
necticut, California, Ohio, and New York for sharing their per-
sonal, frightening, perplexing, and inspiring experiences with
mental illness. I hope that this book will help others, as you have
helped me, to understand.
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Fifty Signs of Mental Illness
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1
Introduction
This book will teach you what you need to know about mental
illness, whether you have been diagnosed with a mental illness,
have untreated problems, or care about someone who may be
mentally ill. The book is organized alphabetically by symptom so
that you can look up the specic symptoms that concern you. In
each section you will learn how the symptom presents itself in
various illnesses.
The symptoms of psychiatric illness frequently overlap and are
easily misdiagnosed. For example, if you have bipolar illness, or
manic depression, you will see, on average, at least three physi-
cians over an eight-year period before you receive a correct di-
agnosis and proper treatment. If you feel anxious all the time, you
may have depression, phobia, obsessive-compulsive disorder,
panic disorder, a drug or alcohol problem, or any number of other
underlying illnesses. This book will inform you about the possi-
bilities and help you and your physician or therapist to make the
correct diagnosis in your case.
In selecting topics, I have tried to use terms that are commonly
used and easily recognized, even if their medical meanings are not
widely known. The extensive index will help you nd detailed
discussions of specic illnesses, medications, and symptoms. Each
topic includes multiple italicized references to other related topics.
For example, when you read about psychosis, you will also be
referred to delusions, hallucinations, and nonsense.
Many of us are initially reluctant to seek help from a profes-
sional. This book will help answer your questions and guide you
to treatment, if treatment is needed. Moreover, each section sug-
gests ways to cope with your specic concerns.
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2 I N T R O D U C T I O N
Everyone Experiences Mental Health Problems
Nearly one of every three of us experiences psychiatric symptoms
each year. These range from the relatively minor, such as a short period
of anxiety or grief during times of stress, to the severely disabling and
painful. Nearly half of us have a family member or a close friend with
serious mental illness. One common illness, depression, is the major cause
of medical disability in the United States. Mental illness can kill: rates of
suicide are as high as one in ve in bipolar illness, one in six in depression,
and one in ten in schizophrenia. Though poorly understood by most peo-
ple, mental illness clearly rivals any other area of medicine in its wide-
spread and serious impact on peoples lives.
Fortunately, mental illness has been coming out of the closet in the past
decade. The respected television journalist Mike Wallace has talked about
his experiences with severe depression. The actor Margot Kidder has can-
didly discussed her recurrent bouts of manic psychosis and her recovery
with medication. The best-selling author Stephen King has written about
his struggles with alcohol and drug abuse. The Oscar-winning box ofce
hits A Beautiful Mind and Shine dramatize the real-life stories of talented
individuals who developed schizophrenia or similar mental illnesses. In
1999, the surgeon general of the United States issued a national report on
mental health and illness, bringing the symptoms and treatment of psy-
chiatric illness to the attention of physicians, public health workers, pol-
iticians, and the general public.
What Causes Mental Illness?
Scientists do not know exactly what causes mental illness. Like
cancer, mental illness can strike anyone and has a variety of causes. Sci-
entists are certain that genetic vulnerability plays a role in many mental
illnesses, since the risk of becoming ill is greater if you have a close relative
who suffers from depression, bipolar illness, schizophrenia, anxiety, or
alcoholism, among others. However, no specic gene has yet been isolated
that causes any of these illnesses. Even identical twins (who have identical
genetic makeup) do not always develop the same mental illnesses.
Everyone agrees that stress plays a role in most mental illness. Even if
you have a genetic vulnerability, the illness might not develop unless some-
thing disturbs your equilibrium. The loss of an important relationship
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I N T R O D U C T I O N 3
for example, through divorceis one of the most serious stresses to the
mind. You may become sick after experiencing extraordinary dangers. On
the other hand, serious illness can arise seemingly out of the blue, without
any obvious stress or loss. You may have always thought of yourself as a
condent and happy person until, over the course of a month or two, you
nd yourself feeling inexplicably hopeless and sad, confused and suspi-
cious, or unable to sleep and concentrate.
Scientists are also uncertain about which physical changes in the brain
lead to psychiatric symptoms. They have studied brain volume, hormone
levels, blood ow, and other physiological data without nding conclusive
answers. We know that abnormal proteins cause plaques in the brains of
people who suffer from Alzheimers dementia, but no smoking gun has
been found for depression, schizophrenia, or other major illnesses. The
medications that treat mental illness have complex effects on certain mol-
ecules in the brain, particularly those involved in the communication be-
tween brain cells. Scientists speculate that abnormal levels of these mole-
cules may cause the underlying illness. This is why psychiatrists often talk
about a chemical imbalance in the brain. Eventually it may be possible to
connect specic genes to specic molecules to specic illnesses and, ulti-
mately, to specic treatments. But the brain is a very complex organ, and
scientists are far from achieving this goal. Scientic breakthroughs have
been rare in other illnesses, such as diabetes and angina, even though the
organs involvedin these cases, the pancreas and the heartare consid-
erably simpler than the brain.
Mental Health Problems Are Treatable
Effective treatments exist for most mental health problems. Some
problems respond very well to psychotherapy, in which a skilled clinician
talks to you and helps you to change your feelings, choices, and behaviors.
For several decades medications have been available for successfully treat-
ing illnesses such as depression, anxiety, bipolar illness, and schizophrenia.
Antidepressant medications are prescribed more widely in the United
States than any other class of medication, with the exception of antibiotics.
They are among the most effective of medications, with at least two-thirds
of sufferers responding within weeks to the rst antidepressant prescribed.
Similar rates of improvement are seen in the treatment of other mental
illnesses.
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4 I N T R O D U C T I O N
Why do our feelings, our thoughts, and our behaviors improve with
medication? Most of us like to think of our minds as independent of our
body and of the effects of medication. In fact, what we call the mind is
inseparable from the physical functioning of the brain. Our ability to
think, to perceive the outside world, and to experience emotions derives
from the continuous cellular growth, electrical transmission, and move-
ment of molecules within our brain. Even our memories are physically
stored in the cellular structure of our brain. Like any other part of the
body, the brain can sometimes experience stress. When that happens (and
it does happen to all of us at one time or another), then either rest, the
attention of friends and family, religious faith, or the passage of timeor
a combination of thesecan lead to recovery. On the other hand, the
brain, like all other organs, can sometimes become sick to the extent that
it will not get better without medical treatment.
Most of us now understand that there are medical explanations and
treatments for many of our emotional pains and worries. Americans make
more than twenty-six million visits to a psychiatrist each year. But most
of us rst turn to our primary care physicians, if we turn to anyone. Un-
fortunately, half of us who experience mental health problems do not seek
treatment at all. And physicians often misdiagnose and undertreat the
psychiatric symptoms that we bring to their attention.
Signs, Symptoms, Syndromes, and Disorders
The fty topics that follow cover the full range of psychiatric dis-
turbances. Most of them are what physicians refer to as signs and symp-
toms. A symptom is a medical complaint that you bring to the attention
of your physician, such as chest pains or feeling sad. A sign is an abnormal
nding by the physician, which you may or may not be aware of, such as
high blood pressure or rapid speech.
A few of the fty topics belong to a broader category, which physicians
refer to as syndromes. A syndrome is a collection of signs and symptoms
that typically occur together but which may be seen in several different
illnesses. For example, pneumonia is a syndrome that typically includes
cough, breathing difculty, and fever but can be caused by several different
germs. In this book mania and psychosis are syndromes made up of a
number of signs and symptoms, most of which are also discussed as sep-
arate topics. Mania and psychosis can occur in several different illnesses,
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I N T R O D U C T I O N 5
though they are most often associated with bipolar disorder and schizo-
phrenia, respectively. Depression can refer to both a symptom and a syn-
drome (when sadness is combined with changes in energy, sleep, and ap-
petite).
Psychiatrists have classied the wide range of mental disturbances into
several specic disorders that are listed in the textbook Diagnostic and
Statistical Manual of Mental Disorders (or DSM; see Recommended Re-
sources). None of these disorders can be diagnosed exclusively on the
basis of laboratory tests or other physical ndings, so psychiatrists have
reached a consensus, based on clinical experience and research, on the
signs and symptoms that are required to make a specic diagnosis. Most
of these illnesses have been well described and reliably diagnosed for de-
cades, if not centuries. The disorders that psychiatrists diagnose and treat
can be grouped into several major categories:
Depression (which affects mood, sleep, appetite, sexual desire, and en-
ergy level).